ELECTION BRIEFING ON ADULT SOCIAL CARE MAY 2018

Adult Services in Haringey has been hit by the largest budget cuts of all London Boroughs since 2015. At the same time demand for services has increased substantially. Whilst the council has inflicted severe service cuts, its duties in meeting the needs of the most vulnerable and their carers are underpinned by law.

Growing numbers of elderly adults and of younger adults with complex disability

Between 2011 and 2017 the number of over 65s in Haringey increased by 18.6% to 27,000, whilst the overall population increased by 11.6% to 285,000. This reflects national trends and the increase is steeper in those aged over 80. Not all of these will require social care but a high proportion will. For example there are over 1700 people diagnosed with dementia (another 40% is estimated to be undiagnosed) and the numbers for frail elderly are not available. A few self-fund but the economic profile of the borough means that large numbers are dependent on benefits and statutory social services, either throughout or once their own means are exhausted.

Similarly, numbers of younger adults with complex disabilities are rising. In particular, there have been major increases in numbers of people with autism, learning disabilities (LD) and mental health problems leaving school and requiring adult social and health care services. At the same time these groups are living longer. Nearly all of these people require substantial support throughout their lives and the funding for this support comes almost exclusively from central and local government and the NHS.

Trends in LBH service user numbers

Contrary to the trend rising numbers of elderly residents, LBH service user numbers over 65 have declined. The number fell from 1820 in April 2014 to 1735 in 2017 and is expected to fall to 1684 in 2023. It is unclear why user numbers have fallen. This might imply greater independence and better health. But a likely factor is the council’s demand management (see below) leading to potential users being deflected from council services. The impact of reablement on selected groups of the elderly and physically disabled may be another factor, although we do not know how long its impact lasts.

While elderly service user numbers are falling, numbers of younger adult service users are rising. A crossover point is projected in 2019-20 when rising numbers of social care users under 65 overtake the falling numbers over 65.

What is London Borough of Haringey’s (LBH) strategy for dealing with these challenges?

LBH’s central government grant has been cut by the average for London (40% since 2010) at a time when the numbers needing adult social care services have been increasing. LBH’s response has been a combination of ‘demand management’ and privatising assets that previously served these users. This is Haringey’s ‘new model’ of social care:

LBH has closed more day and residential centres than any other Borough – 17 centres in all.

The only dedicated centre for autistic adults, Roundway, has been shut.

Osborne Grove Nursing Home is now to be closed and the remaining residents removed before the local election purdah.

Ermine Road for learning disabled and the Haynes for dementia, are now the only in-house provision for Haringey’s most vulnerable residents. Both are planned for privatisation.

Demand management is now at the forefront of LBH’s Adult Services strategy for stemming demand.

LBH’s evidence supporting the effectiveness of this demand management strategy consists of a handful of case studies of councils promoting their own achievements on the Local Government Association’s website. There is no proper evidence that examines outcomes for users when these measures are used on a larger scale.

What happened since 2015 in adult services commissioned by LBH?

Adverse CQC ratings of ‘overall inadequate’ for providers of residential, supported living and home care, providing contracted services for the council in recent years, is considerable. These ratings mean medicines not given, clients not washed, records not kept, daily visits missed or shortened to 15 minutes – as press and TV reports on Sevacare, the largest homecare provider in Haringey, showed.

According to a 2017 Which? Survey of CQC data, 41% of care beds in Haringey are rated ‘inadequate’ or ‘need improvement’.

Failure to achieve adult services savings

Savings in adult services sought between 2015 and 2018 by a drastic programme of redirecting service users away from close day centres and into day opportunities, turn out to be only £1.15m in 2017-18 after fully implementing the cuts. One councillor recently pointed out that this saving could have been gained by raising council tax by 1% and avoiding all the service closures.

Critique of the Haringey's new model social care

Adult Services data shows that 30 LD users out of 141 using new day activities had a reduction in hours and only 15 an increase.

Community day opportunities are unsuitable for some people with high-need autism, LD and dementia where an unprotected environment could pose serious risks. Day centres with expert staff are essential in providing a secure base from which to access carefully selected activities in the community.

The remaining two day centres have insufficient capacity for users transferring from closed centres (see above). The Haynes Hub for moderate to advanced dementia has capacity for 20 with long waiting list. The total number needing support of some kind in Haringey is over 700.

These practices could mean LBH is in breach of its Care Act duties.

Adult Services have so far failed to provide data to answer these questions: -

Are parents being increasingly expected to care for their adult children with LD living at home? Likewise, loved-ones to care for adults with dementia, frailty and disability? For example, if day centres were providing 5 days a week, 6 hours a day before being closed, and if daily trips to community opportunities now are shorter, are adults spending more time at home? Are family carers providing extra home care in addition to normal daily care?

Are users in residential care and supported living offered only community activities supported by own staff not council staff? Adult Services data show that, of the 41 users at Ermine Road in April 2016 who lived in Supported Living or residential provision, only four remained at Ermine Road in August 2017 after the new model care was introduced – clear evidence of exclusion.

Users in residential/supported living and in family homes are treated differently. For example, if the former group are excluded from the LBH learning disability day centre and out of borough provision, does this raise a question about discriminating between two different groups of vulnerable adults with similar needs but living in different settings unrelated to need?

Where’s the research to support Haringey’s new model of social care?

How have the council assessed and how do they plan to monitor the impact of the new model on users and family carers?

No comparison has been shown of the impact of old and new models on care packages, ie on whether individual packages experienced a reduction or increase in a) costs and b) hours spent of care provision, or the resulting impact on users and carers.

Where are the assessments of Care Act duties to ensure continuity and equity of care for vulnerable adults?

The only evidence is results of assessments and reviews from 2016. But these are resources-driven and are not transparent.

Alternative Provision of Social Care

The council has now adopted the Ethical Care Charter. But funding this will be a challenge. Thankfully the outgoing Council agreed to raise the social care precept by 3% in 2018-19. A similar rise may be needed in 2019-20, and commentators nationally are saying that even the maximum precept will still not be enough.

Costs can be reduced by scrapping agency contracting-out and bringing care back ‘in house’ or through a non-profit enterprise. The latter would offer good pay with good quality care, and democratic control, by stripping out private profit. On our web site, you will find a proposal about how to do this. Care should not just be seen as a cost. It’s also a major employment sector and capable of job-creating growth.

The May elections in Haringey offer the chance of a change in direction. We need a change in Council policy away from the fatalistic pursuit of austerity and the adoption of an approach that puts the needs of the borough’s most vulnerable residents at the top of its agenda. We demand:

re-reinstatement of proper monitoring and support from local councils for all social workers and all who work in the care sector

implementation of appropriate statutory training for those working in the care sector including social workers and all care and support workers and that this is evidenced prior to contracting a provider.

dedicated building-based provision of day centres and other support services.

London Living Wage for all care and support staff working in social care, and demand that there should be adequate central government funding to make this sustainable in the long term.

ending all zero-hour contracts in care/support services unless it's a real choice/decision from the employee, for example for students.

the rights of all individuals to have a decent quality of life, to include adequate support as required